1317. Prevalence and Risk Factors for Asymptomatic Clostridium difficile Carriage
Session: Oral Abstract Session: Challenges in C. difficile Infection Surveillance
Saturday, October 20, 2012: 11:45 AM
Room: SDCC 29 ABCD
Background: C. difficile infection (CDI) incidence has increased dramatically over the last decade. Recent studies suggest asymptomatic carriers may be an important reservoir of C. difficile (CD) in healthcare settings. We sought to identify the prevalence and risk factors for asymptomatic CD carriage on admission to the hospital.

Methods:

Patients admitted to medical and surgical wards at Barnes-Jewish Hospital (BJH) without diarrhea and anticipated length of stay of >48 hours were prospectively enrolled from Jun 21, 2010, through Oct 25, 2011. Stool, or rectal swabs were collected  within 48 hours of admit and stored at -30C.  Demographics, comorbidites, and healthcare and medication exposures 90 days prior to admission  were collected. Specimens were heat shocked at 80C for 10 min and inoculated into cycloserine, cefoxitin, manitol broth with lysozyme and taurocholate (Anaerobe Systems). Growth was plated onto blood agar. CD was identified by colony and Gram stain morphology, and standard biochemical tests.CD isolates were subcultured in BHI, and culture supernatant tested for GDH and toxins A and B (C. DIFF QUIK CHEK COMPLETE). Chi-square/Fisher’s exact test was used for data analysis.

Results:

259 subjects had an admission stool/swab specimen.  204 (79%) were not colonized, 40(16%) had toxigenic CD (TCD), and 15(6%) had nontoxigenic CD. There were no differences between TCD colonized and uncolonized subjects for age (mean 56 v 58, p=.46) or proportion that were admitted to the medicine service (83% v 88%, p=.32), admitted from another healthcare facility (33% v 24%, p=.23), or reason for admission (p=.45). There were no differences in any of 12 comorbidities or past history of CDI (1% v 2%, p=.82). There were also no differences in antibiotics exposure in the 90 days prior to admission (55% v 56%, p= .91), or hospitalization in the prior 90 days (50% v 50%, p=.43).  4(2%) TCD colonized patients and 2(1%) uncolonized patients were diagnosed with CDI (p=.07).

Conclusion: There was a high prevalence of TCD colonization on admission to BJH. There were no associations between demographics or antibiotic or healthcare exposures between colonized and uncolonized patients.  Asymptomatic TCD carriers may be an important source of TCD in acute care facilities.

Erik Dubberke, MD, MSPh, Infectious Disease, Washington University School of Medicine, St. Louis, MO, Faisal Alasmari, MD, Infectious Diseases, Washington University School of Medicine, St.Louis, MO, Sondra Seiler, BA, Washington University School of Medicine, St. Louis, MO, Tiffany Hink, BS, Infectious Diseases, Washington University Schoold of Medicine, St Louis, MO and Carey-Ann Burnham, PhD, Pediatrics, Pathology and Immunology, Washington University School of Medicine, St Louis, MO

Disclosures:

E. Dubberke, Optimer: Consultant, Grant Investigator and Speaker's Bureau, Consulting fee, Research support and Speaker honorarium
Pfizer: Consultant, Consulting fee
Merck: Consultant and Investigator, Consulting fee and Research support
Sanofi Pasteur: Consultant, Consulting fee
Viropharma: Investigator, Research support

F. Alasmari, None

S. Seiler, None

T. Hink, None

C. A. Burnham, None

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